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Why This Topic Is Important
Sexual health is a critical component of overall teen health and is influenced by complex factors including biology, socioeconomics, community environments, relationships with family and peers, media, and access to health care and education (1). While sexuality is a normal part of adolescent development, sexual activity can have serious consequences, including sexually transmitted infections (STIs) and unintended pregnancy. It is estimated that although young people ages 15-24 make up 13% of the U.S. population, they represent around 25% of the sexually active population and account for around 50% of all new STI cases each year (1, 2).

Among infectious diseases that must be reported to the U.S. government, chlamydia and gonorrhea are the most common, with young people ages 15-24 having the highest rates of infection when compared with other age groups (1, 2). Nationwide, African American/black youth experience especially high rates of chlamydia and gonorrhea; in 2021, black youth ages 15-19 were diagnosed with chlamydia at more than five times the rate for white youth of the same age, and with gonorrhea at nearly 12 times the rate of their white peers (2).

Chlamydia and gonorrhea infections are often asymptomatic, particularly in women, so regular screenings are critical in order to provide timely treatment and to reduce disease transmission (1, 3). If untreated, chlamydia and gonorrhea can lead to chronic pain, pelvic inflammatory disease, infertility, and adverse reproductive outcomes (1, 3).
For more information on teen sexual health, see kidsdata.org’s Research & Links section. Also see kidsdata.org’s Teen Births topic.

Sources for this narrative:

1.  National Academies of Sciences, Engineering, and Medicine. (2021). Sexually transmitted infections: Adopting a sexual health paradigm. National Academies Press. Retrieved from: https://www.nap.edu/catalog/25955/sexually-transmitted-infections-adopting-a-sexual-health-paradigm

2.  Centers for Disease Control and Prevention. (2023). Sexually transmitted disease surveillance 2021. Retrieved from: https://www.cdc.gov/std/statistics

3.  U.S. Department of Health and Human Services. (2020). Sexually transmitted infections national strategic plan for the United States: 2021–2025. Retrieved from: https://www.hhs.gov/programs/topic-sites/sexually-transmitted-infections/plan-overview
Policy Implications
In order to make safe, informed choices about sexual activity, young people need accurate, appropriate, and comprehensive sexual health information; access to quality health care; and supportive families, peers, and communities (1, 2). Sexually transmitted infections (STIs), in particular, pose a major threat to sexual health—despite being largely preventable and curable—and disproportionately impact youth (2). The lifetime direct medical costs associated with STIs acquired in a single year among U.S. young people ages 15-24 have been estimated at $4.2 billion (2).

California law requires integrated, comprehensive sexual health and HIV prevention education in middle school and high school, and mandates that instruction and materials be appropriate for students of all ages, genders, racial/ethnic and cultural backgrounds, sexual orientations, and those with disabilities (3). In addition to providing tailored education and health services for preteens and teens, efforts to improve youth sexual health should focus on promoting protective factors associated with reduced sexual risk-taking (e.g., positive family and peer relationships) and addressing underlying social conditions and systemic barriers (e.g., racial and income disparities in access to quality health care and education) that influence health behaviors and outcomes (1, 2). Although California has a strong track record of promoting adolescent health, state data show persistent disparities in teen sexual and reproductive health by race/ethnicity and geography (1).

California youth have the right to confidential sexual health services—related to sexually transmitted diseases (for ages 12 and older), contraception, pregnancy, and abortion—but teens, doctors, and parents may not fully understand those rights (4). The state's strengthened Confidentiality of Medical Information Act now prohibits health care insurers and providers from disclosing sensitive medical information to anyone (including primary policyholders or parents of a minor patient) without a patient's written authorization (5).

Policy and program options to improve teen sexual health include:
  • Ensuring that public health efforts and reimbursement policies support broad, routine screening of youth for STIs and that sexual health services are accessible (especially in rural areas), affordable, culturally appropriate, and provide teens with convenient options for receiving care, such as in school- and community-based settings or during non-traditional hours (1, 2, 6)
  • Supporting implementation of the STI national strategic plan, which advances coordinated strategies across government to remove barriers to STI prevention, screening, and treatment, especially for disproportionately affected groups (2, 7)
  • Expanding effective community-based approaches across multiple settings (e.g., local organizations, workplaces, and faith communities) to increase public dialogue and remove stigma around STIs (2)
  • Advancing evidence-based resources and programs for parent education and skills training on how to prevent STIs and promote healthy teen sexuality (2)
  • Promoting routine sexuality education by pediatric and adolescent health care providers as a supplement to information provided in school and at home, and working to address reimbursement, training, and time issues that can be barriers to this education (2, 8)
  • Ensuring that the California Healthy Youth Act, which expanded sexual education requirements for schools, is implemented effectively across the state (3, 9)
  • Supporting efforts to use digital and social media as positive tools to promote healthy sexual development, and to help parents and youth manage negative media influences (2)
  • Encouraging policies and programs that strengthen family relationships (including parent-child communication), help youth develop positive and meaningful connections to peers and other adults, and provide safe and supportive community and school environments (2)
  • Promoting cross-sector efforts that go beyond individual factors to address larger cultural and structural forces that give rise to teen sexual health disparities, such as discrimination, poverty, inequitable education and employment opportunities, and lack of access to health care (1, 2)
For more policy ideas and research on this topic, see kidsdata.org’s Research & Links section or visit Guttmacher Institute and Essential Access Health. Also see Policy Implications on kidsdata.org under Teen Births and Health Care.

Sources for this narrative:

1.  Campa, M., et al. (2022). California adolescent sexual health needs index, 2018. California Department of Public Health, Maternal, Child and Adolescent Health Division. Retrieved from: https://www.cdph.ca.gov/Programs/CFH/DMCAH/CDPH%20Document%20Library/Data/Adolescent/CA-Adolescent-Sexual-Health-Needs-Index-2018.pdf

2.  National Academies of Sciences, Engineering, and Medicine. (2021). Sexually transmitted infections: Adopting a sexual health paradigm. National Academies Press. Retrieved from: https://www.nap.edu/catalog/25955/sexually-transmitted-infections-adopting-a-sexual-health-paradigm

3.  California Department of Education. (2023). California's health education initiatives. Retrieved from: https://www.cde.ca.gov/ci/he/cf/cahealthfaq.asp

4.  Guttmacher Institute. (2023). An overview of consent to reproductive health services by young people. Retrieved from: https://www.guttmacher.org/state-policy/explore/overview-minors-consent-law

5.  Cal. A. B. 1184 (2021-2022). Retrieved from: https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202120220AB1184

6.  Whitfield, B., et al. (2022). Offering sexual and reproductive health services to adolescents in school settings can create more equitable access. Child Trends. Retrieved from: https://www.childtrends.org/publications/offering-sexual-and-reproductive-health-services-to-adolescents-in-school-settings-can-create-more-equitable-access

7.  U.S. Department of Health and Human Services. (2020). Sexually transmitted infections national strategic plan for the United States: 2021–2025. Retrieved from: https://www.hhs.gov/programs/topic-sites/sexually-transmitted-infections/plan-overview

8.  Breuner, C. C., et al. (2022). Sexuality education for children and adolescents. Pediatrics, 138(2), e20161348. Retrieved from: https://publications.aap.org/pediatrics/article/138/2/e20161348/52508/Sexuality-Education-for-Children-and-Adolescents

9.  Adolescent Sexual Health Work Group. (2021). Resources to support implementation of the California Healthy Youth Act. Retrieved from: https://www.ashwg.org/sites/ashwg/assets/File/ASHWGResourceList-100220_NA_SD.pdf
How Children Are Faring
According to survey data for 2017-2018, an estimated 87% of California teens ages 14-17 had never had sex. Young people who engage in sexual activity may be at risk for sexually transmitted infections such as chlamydia and gonorrhea; in 2018, more than 48,000 new chlamydia and gonorrhea infections were reported among teens ages 15-19 statewide.

In 2020, disruptions related to the onset of the COVID-19 pandemic likely altered youth sexual behaviors and access to sexual health services, introducing uncertainty in the interpretation of case data. Compared with 2019, reported cases of chlamydia among California youth ages 10-19 fell sharply in 2020, from 788 infections per 100,000 youth to 573 per 100,000, echoing national trends. While rates fell in all but one county with data over this period, county-level variation remained wide, ranging from fewer than 250 to more than 800 cases per 100,000 in 2020. As in previous years, rates of chlamydia infection were more than three times higher for female youth ages 10-19 than for their male counterparts in 2019 and 2020, statewide and nationally.

Reported cases of youth gonorrhea were comparatively stable between 2019 and 2020. At the national level, the rate rose from 229 to 245 infections per 100,000 young people ages 10-19—an increase of around 10,000 cases. In California, the change was smaller and differed by gender. Overall, rates fell by less than one case per 100,000 youth, driven by a drop from 165 to 162 cases per 100,000 females, offsetting an opposing increase from 99 to 101 cases per 100,000 males.